Good question - my answer might be a pile of pooh, but here goes,
The prehospital application for TnT is not of any benefit to the ambulance
personnel what-so-ever.
At present...
I see it as a way of helping the A&E dept. TnT is more commonly used to rule
out unsatble angina. At the Royal Sussex County Hospital, Brighton the A&E
staff use it to determine the need for admission or discharge for patients
with possible unstable angina. An initial test is performed when the patient
comes into A&E and a second some 4 hours later. If both tests are negative
the chances are very slim indeed that a coronary event has taken place and
unstable angina can be ruled out. The results will directly influence the
desiscion whether to admit the patient or to seek another course of
treatment.
My thoughts are...
To reduce the time by up to one hour earlier than is presently being
achieved. The physiscians do not have to wait the full 4 hours for the
results and as a result free up much needed A&E beds.
Most paramedics will cannulate a patient wit active or recent (past hour) of
cardiac type chest pains. We could take a blood sample at that point and
place it in the unit for testing. If one accepts that minimum times are: on
scene to hospital- 30 minutes (by the time we get to A&E we will have the
results of the first test)and handover time (lets be generous) of 10 minutes
and the test is performed within 10 minuttes of first A&E staff making
contact with the patient we can save 50 minutes. This is being minimilistic
on times. Most hopsitals cant achieve these times on thrombolysis let alone
angina.
Therefore we can potentially help clear the A&E dept of ruled out angina
patients 50 minutes sooner than is being done at present. This as got to put
a smile on the A&E consultants face.
Your other point about the units not being battery operated I accept and
this problem can be overcome by linking the unit to the vehicle battery
management system as they are ambulance friendly. We already do this with
incubators, pulse Ox, nebulisers, cardiac monitors (some), fluid warmers
etc.
It's just a thought and may not work.
Mike Bjarkoy
Paramedic
Sussex
-----Original Message-----
From: [log in to unmask]
[mailto:[log in to unmask]]On Behalf Of Timothy J Coats
(SURG) 7728
Sent: 08 June 2000 10:08
To: [log in to unmask]
Subject: RE: cardiac enzymes
> The UK perspective is 75 minutes for call for help which may exclude
cardiac
> enzymes out of the equation.
> I am still convinced that they have a very definate role to play but the
A&E
> dept in the UK are playing 'catch up' with developing technologies of
> prehospital care. Not that long ago I was approached by an ambulance
> technician who asked what the point of a BP and 12 lead ECG' were and the
> A&E nurse backed up the question. With attitudes like that I believe that
> TnT etc are a few years down the line. But I personnally agree that they
> have a place in prehospital care.
Could you expand on the possible place in pre-hospital care?
At first glance: typical chest pain for AMI, no ST elevation on 12
lead = still not a candidate for pre-hospital thrombolysis, so does a
pre-hospital cardiac enzyme result actually help?
How do you see a pre-hospital enzyme result changing patient
management?
(Practical difficulties at present - stix testing for troponins or
myoglobin requires a heparinised venous sample and needs a 15
minute incubation in a machine - at present no battery version).
Tim
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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